<%@ page language="java" contentType="text/html; charset=ISO-8859-1"
    pageEncoding="ISO-8859-1"%>
<%@ taglib prefix="form" uri="http://www.springframework.org/tags/form"%>
<%@ taglib uri="http://java.sun.com/jsp/jstl/core" prefix="c"%>  
<%@ taglib prefix="sec" uri="http://www.springframework.org/security/tags" %>
<!DOCTYPE html>
<html>
<link rel="stylesheet" href="resources/mytheme/css/main.css">
<head>
<meta http-equiv="Content-Type" content="text/html; charset=ISO-8859-1">
<title>Hospital Information</title>


<link rel="stylesheet" href="resources/mytheme/css/jquery-ui.css" type="text/css" media="screen" />
<script type="text/javascript" src="resources/js/jquery-1.8.3.js"></script>
<script type="text/javascript" src="resources/js/jquery-ui.js"></script>
<link rel="stylesheet" href="resources/mytheme/css/jquery.ui.chatbox.css">
<script type="text/javascript" src="resources/js/jquery.ui.chatbox.js"></script>
<script src="http://ajax.googleapis.com/ajax/libs/jquery/1.11.1/jquery.min.js"></script>

<script type="text/javascript">

		$(document).ready(function()
		{
			var box = null;
			
			$("#chatLink").click(function(event, ui)
			{
				if(box)
				{
					box.chatbox("option", "boxManager").toggleBox();
				}
				else
				{
					box = $("#chat_div").chatbox(
					{
						id:"Runnable",
                        user:
						{
							key : "value"
						},

						title : "Acme Claims Health Chat",
						messageSent : function(id, user, msg)
						{
							$("#log").append(id + " said: " + msg + "<br/>");
                            $("#chat_div").chatbox("option", "boxManager").addMsg(id, msg);
                        }
					});
				}
			});
		});
    </script>
</head>
<body>
	<div id="headerContainer">
		<div class="centerContainer">
		<p id="demo" style="visibility: hidden;" />
		<div id="chat_div" ></div>
			<ol>
			<sec:authorize ifAllGranted="ROLE_ADMIN">
				<li><a href="AdminUsers">Users</a></li>
				<li><a href="AdminRejectedClaims">Rejected Claims</a></li>
				<li><a href="AdminAcceptedClaims">Accepted Claims</a></li>
				<li><a href="AdminAllClaims">All Claims</a></li>
			</sec:authorize>
			<sec:authorize ifAnyGranted="ROLE_ADMIN, ROLE_ADJUSTER">
				<li><a href="InsuranceAdjuster">Adjust Claims</a></li>
			</sec:authorize>
			</ol>
		</div>
		<!-- /centerContainer -->

	</div>
	<!-- /headerContainer -->

	<div id="secondHeaderContainer">
		<div class="logoContainer">
			<img src="resources/mytheme/images/logo2.png" alt="logo" width="205"
				height="89">
		</div>
		<!-- /logoContainer -->
		<div class="navContainer">

			<ul id="navWrapper">
				<li><a href="/AcmeClaims">Home</a></li>
				<sec:authorize ifNotGranted="ROLE_ADMIN">
				<c:if test="${pageContext.request.userPrincipal.name != null}">
					<li>
						<!-- Menu A --> <a href="#">Claims</a>
						<ul>
							<li><a href="ClaimPortal">Submit Claim</a></li>
							<li><a href="MyAccount">View Claim</a></li>
						</ul>
					</li>
					<li><a href="MyAccount">My Account</a></li>
				</c:if>
				</sec:authorize>
				<li><a href="locatedoctor">Find a Doctor</a></li>
			</ul>
		</div>
		<!-- /navContainer -->
	</div>
	<!-- /secondHeaderContainer -->

	<div id="thirdHeaderContainer">
		<div class="lowerheaderContainer">
			<c:if test="${pageContext.request.userPrincipal.name != null}">
				<ol>
					<li><a href="<c:url value="/MyAccount" />">${pageContext.request.userPrincipal.name}</a></li>
					<li>|</li> 
	                <li><a href="<c:url value="/Logout" />" > Logout</a></li>
                 </ol> 
			</c:if>
			<c:if test="${pageContext.request.userPrincipal.name == null}">
				<ol>
					<li><a href="Login">Log-In</a></li>
					<li>|</li>
					<li><a href="register">Register</a></li>
				</ol>
			</c:if>
		</div>
		<!-- /lowerHeader-->
	</div>
	<!--/thirdHeaderContainer"-->
	<form:form commandName="claim">
		<div id="mainCenterHolder">
			<div class="mainCenterContainerLogin">
				<div class="claimNav">
					<h1>Navigation</h1>
						<ul>
						  <li class="diffrent"><input type="submit" value="Claim Creation" name="_target0"/></li>
						  <li class="diffrent"><input type="submit" value="Injury Info&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;--" name="_target1"/></li>
						  <li>Hospital Info</li>
						  <li>Medicare</li>
						  <li>Private Cov.</li>
						  <li>Claim Registration </li>
						</ul>
				
				</div><!-- /ClaimNav -->
				<div class="headerTitle">
					<h1>Hospital Info</h1>
				</div>
				<div class="claimTable4">
					<table>
						<tr>
							<td>
								<label>Hospital Name:</label>
							</td>
							<td><form:input name="hospName" path="hospitalName" maxlength="30" /></td>
						</tr>
						<tr>
							<td>
								<label>Admission Date:</label></td>
							<td><form:input type="date" name="adDate" path="hospAdmitDate" /></td>
						</tr>
						<tr>
							<td>
								<label>Discharge Date:</label>
							</td>
							<td><form:input type="date" name="disDate" path="hospDischargeDate" /></td>
						</tr>
						<tr>
							<td>
								<label>Name of Physician:</label>
							</td>
							<td><form:input name="physName" path="admittingPhysician" maxlength="65" /> </td> 
						</tr>
						<tr>
							<td>
								<label>Symptoms/Diagnosis:</label>
							</td>
							<td><form:textarea id="styled"  name="symptom" path="diagnosis" rows="10" cols="40" maxlength="300" /></td>
						</tr>
					</table>
					<br>
					<div class="nextLink">
						<input type="submit" value="Previous" name="_target1">
						<input type="submit" value="Next" name="_target3">
					</div>
				</div>
			</div>
		</div>
	</form:form>
		<div id="footer">
			<div class="footerwrap">
			<div class="foota">
			<br>
			<p>Connect With Us</p>
				<div id="footapad"><a href="#"><img src="resources/mytheme/images/fb.png" id="facebook" alt="logo" width="67" height="73"/></a>
				<a href="#"><img src="resources/mytheme/images/twit.png" id="twitter" alt="logo" width="65" height="73"/></a>
				<a href="#"><img src="resources/mytheme/images/pin.png" id="pintrest" alt="logo" width="67" height="73"/></a>
				
				
				</div>
			</div>
			<div class="footb">
			<br>
				<p>Toll Free: 1-800-382-3827</p>
				  <ol>
					<li>Acme Corporate</li>
					<li>143 23rd Ave South</li>
					<li>Fargo, North Dakota 58121</li>
				</ol>
			</div>
			<div class="footc">
			<br>
				<p>Need Help?</p>
				  <ol>
				    <li><a href="#" id="chatLink">Join Live Chat</a></li>
					<li><a href="ContactUs">Contact Us</a></li>
					<li><a href="FAQ">FAQ's</a></li>
				</ol>
				 
			</div>
			</div><!-- FooterWrap -->
		</div><!-- Footer -->
</body>
</html>